title: Re-use of explanted osteosynthesis devices: a reliable and inexpensive reprocessing protocol.
abstract: BACKGROUND
  Orthopaedic surgical treatments emphasizing immobilization using open reduction and internal fixation with osteosynthesis devices are widely accepted for their efficacy in treating complex fractures and reducing permanent musculoskeletal deformity. However, such treatments are profoundly underutilized in low- and middle-income countries (LMIC), partially due to inadequate availability of the costly osteosynthesis devices. Orthopaedic surgeons in some LMIC regularly re-use osteosynthesis devices in an effort to meet treatment demands, even though such devices typically are regulated for single-use only. The purpose of this study is to report a reprocessing protocol applied to explanted osteosynthesis devices obtained at a leading trauma care hospital.
  
  
  METHODS
  Explanted osteosynthesis devices were identified through a Register of Explanted Orthopaedic Prostheses. Guidelines to handle ethical issues were approved by the local Ethical Committee and informed patient consent was obtained at the time of explant surgery. Primary acceptance criteria were established and applied to osteosynthesis devices explanted between 2005 and 2008. A rigorous protocol for conducting decontamination and visual inspection based on specific screening criteria was implemented using simple equipment that is readily available in LMIC.
  
  
  RESULTS
  A total of 2050 osteosynthesis devices, including a large variety of plates, screws and staples, were reprocessed using the decontamination and inspection protocols. The acceptance rate was 66%. Estimated labour time and implementation time of the protocol to reprocess a typical osteosynthesis unit (1 plate and 5 screws) was 25 min, with an estimated fixed cost (in Italy) of €10 per unit for implementing the protocol, plus an additional €5 for final sterilization at the end-user hospital site.
  
  
  CONCLUSIONS
  This study was motivated by the treatment demands encountered by orthopaedic surgeons providing medical treatment in several different LMIC and their need for access to basic osteosynthesis devices. The rigorous decontamination protocol and generalized inspection criteria proved useful for efficiently screening a large volume of devices. Given that re-used osteosynthesis devices can yield satisfactory results, this study addresses potential complications of re-used devices and valid concerns that relate to patient safety. Implementing this defined reprocessing protocol into existing re-use practises in LMIC helps to limit the risks of inadequate sterilization and structural failure without adding additional risks to patients receiving re-used devices.
authors.affiliation: Medical Technology Lab, Rizzoli Orthopaedic Institute, Bologna, Italy. vdanesi@tecno.ior.it
authors.forename: Valentina
authors.initials: V
authors.lastname: Danesi
authors.forename: Luca
authors.initials: L
authors.lastname: Cristofolini
authors.forename: Susanna
authors.initials: S
authors.lastname: Stea
authors.forename: Francesco
authors.initials: F
authors.lastname: Traina
authors.forename: Alina
authors.initials: A
authors.lastname: Beraudi
authors.forename: Luca
authors.initials: L
authors.lastname: Tersi
authors.forename: Melinda
authors.initials: M
authors.lastname: Harman
authors.forename: Marco
authors.initials: M
authors.lastname: Viceconti
mesh_terms: D017954:Africa South of the Sahara; D003666:Decontamination / Q000191:economics / Q000379:methods / Q000592:standards; D003906:Developing Countries; D004866:Equipment Contamination / Q000517:prevention & control; D017743:Equipment Reuse / Q000191:economics / Q000592:standards; D004869:Equipment Safety / Q000191:economics / Q000592:standards; D005593:Fracture Fixation, Internal / Q000191:economics / Q000295:instrumentation* / Q000592:standards; D017408:Guidelines as Topic; D006801:Humans; D016268:Internal Fixators / Q000191:economics / Q000592:standards / Q000600:supply & distribution*; D059027:Recycling / Q000379:methods; D013242:Sterilization / Q000191:economics / Q000379:methods / Q000592:standards